Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted

Bellal Joseph; Moutamn Sadoun; Hassan Aziz; Andrew Tang; Julie L Wynne; Viraj Pandit; Narong Kulvatunyou; Terence O'Keeffe; Randall S Friese; Peter Rhee

doi:10.1177/000313481408000123

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Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted

Journal article

Open access

Peer reviewed

Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted

Bellal Joseph, Moutamn Sadoun, Hassan Aziz, Andrew Tang, Julie L Wynne, Viraj Pandit, Narong Kulvatunyou, Terence O'Keeffe, Randall S Friese and Peter Rhee

The American surgeon, Vol.80(1), pp.43-47

01/2014

DOI: 10.1177/000313481408000123

PMID: 24401514

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Abstract

Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CT with prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neurosurgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using χ(2) and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older (P < 0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission (P < 0.001), were more likely to present with an abnormal neurologic examination (P = 0.004), and had higher hospital and intensive care unit lengths of stay (P < 0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P < 0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information.

Adult

Aged

Aged, 80 and over

Anticoagulants - adverse effects

Aspirin - adverse effects

Brain Injuries - complications

Brain Injuries - diagnostic imaging

Cohort Studies

Disease Progression

Female

Head Injuries, Closed - complications

Head Injuries, Closed - diagnostic imaging

Humans

Intracranial Hemorrhages - chemically induced

Intracranial Hemorrhages - diagnostic imaging

Intracranial Hemorrhages - epidemiology

Intracranial Hemorrhages - etiology

Logistic Models

Male

Middle Aged

Multivariate Analysis

Registries

Retrospective Studies

Risk Factors

Ticlopidine - adverse effects

Ticlopidine - analogs & derivatives

Tomography, X-Ray Computed

Warfarin - adverse effects

Details

Title: Subtitle: Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted
Creators: Bellal Joseph - University of Arizona
Moutamn Sadoun - University of Arizona
Hassan Aziz - University of Arizona
Andrew Tang - University of Arizona
Julie L Wynne - University of Arizona
Viraj Pandit - University of Arizona
Narong Kulvatunyou - University of Arizona
Terence O'Keeffe
Randall S Friese - University of Arizona
Peter Rhee - University of Arizona
Resource Type: Journal article
Publication Details: The American surgeon, Vol.80(1), pp.43-47
DOI: 10.1177/000313481408000123
PMID: 24401514
NLM abbreviation: Am Surg
ISSN: 0003-1348
eISSN: 1555-9823
Language: English
Date published: 01/2014
Academic Unit: Surgery
Record Identifier: 9984701546102771

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32 Times Cited - Web of Science